Download as PDF
38901
Federal Register / Vol. 79, No. 131 / Wednesday, July 9, 2014 / Notices
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Data collection method or project activity
Total burden
hours
Average hourly wage rate *
Total cost
burden
1. Hospital Informed Consent Baseline and Final Assessment ......................
2a. Frontline Staff Pre-/Post-Training Quiz .....................................................
2b. Hospital Leader Pre-/Post-Training Quiz ...................................................
3. Monthly Check-in .........................................................................................
4. Frontline Clinical Staff Survey .....................................................................
5a. Interview—Clinical Staff .............................................................................
5b. Interview—Hospital Leaders ......................................................................
6. Rapid Feedback Patient Survey ..................................................................
7. Secondary data ...........................................................................................
20
512
26
20
512
48
24
320
4
40
341.33
17.33
60
128
48
24
26.67
20
$42.78
33.62
51.95
42.78
33.62
33.62
51.95
22.33
42.78
$1,711
11,476
900
2,567
4,303
1,614
1,247
596
856
Total ..........................................................................................................
........................
........................
........................
25,270
sroberts on DSK5SPTVN1PROD with NOTICES
The average hourly wage rate of
$42.78 for the informed consent
baseline, readiness assessment, and
monthly check-in was calculated based
on the 2013 average of the mean hourly
wage rate for healthcare practitioners
and medical occupations (all
professions) of $33.62 and mean hourly
wage rate for medical and health
services managers, $51.95.
The average hourly rate of $33.62 of
hospital staff pre- and post-training quiz
and in-depth interviews was calculated
based on the 2013 average of the mean
hourly wage rate for healthcare
practitioners and medical occupations
(all professions), $33.62.
The average hourly rate of $51.95 for
hospital leaders pre- and post-training
quiz and in-depth interview was
calculated based on the 2013 mean
hourly wage rate for medical and health
services managers, $51.95.
The average hourly wage rate for
patients of $22.33 was calculated on the
2013 mean hourly wage rate for all
occupations. Mean hourly wage rates for
these groups of occupations were
obtained from the Bureau of Labor &
Statistics on ‘‘Occupational
Employment and Wages, May 2013’’
found at the following URL: http://
www.bls.gov/oes/current/oes_
nat.htm#b29-0000.htm.
Request for Comments
In accordance with the Paperwork
Reduction Act, comments on AHRQ’s
information collection are requested
with regard to any of the following: (a)
whether the proposed collection of
information is necessary for the proper
performance of AHRQ health care
research and healthcare information
dissemination functions, including
whether the information will have
practical utility; (b) the accuracy of
AHRQ’s estimate of burden (including
hours and costs) of the proposed
collection(s) of information; (c) ways to
enhance the quality, utility, and clarity
of the information to be collected; and,
VerDate Mar<15>2010
20:08 Jul 08, 2014
Jkt 232001
(d) ways to minimize the burden of the
collection of information upon the
respondents, including the use of
automated collection techniques or
other forms of information technology.
Comments submitted in response to
this notice will be summarized and
included in the Agency’s subsequent
request for OMB approval of the
proposed information collection. All
comments will become a matter of
public record.
[FR Doc. 2014–15807 Filed 7–8–14; 8:45 am]
Comments on this notice must be
received by August 8, 2014.
ADDRESSES: Written comments should
be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by
email at doris.lefkowitz@ahrq.hhs.gov.
Copies of the proposed collection
plans, data collection instruments, and
specific details on the estimated burden
can be obtained from the AHRQ Reports
Clearance Officer.
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
email at doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
BILLING CODE 4160–90–M
Proposed Project
Dated: June 25, 2014.
Richard Kronick,
AHRQ Director.
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.
ACTION: Notice.
AGENCY:
This notice announces the
intention of the Agency for Healthcare
Research and Quality (AHRQ) to request
that the Office of Management and
Budget (OMB) approve the proposed
information collection project: ‘‘Taking
Efficiency Interventions in Health
Services Delivery to Scale.’’ In
accordance with the Paperwork
Reduction Act of 1995, AHRQ invites
the public to comment on this proposed
information collection.
This proposed information collection
was previously published in the Federal
Register on April 8th, 2014, and
allowed 60 days for public comment. No
comments were received. The purpose
of this notice is to allow an additional
30 days for public comment.
SUMMARY:
PO 00000
Frm 00052
Fmt 4703
Sfmt 4703
DATES:
Taking Efficiency Interventions in
Health Services Delivery to Scale
The primary care workforce is facing
imminent clinician shortages and
increased demand. With the
implementation of the Affordable Care
Act (ACA), Federally Qualified Health
Centers (FQHCs) are expected to play a
major role in addressing the large
numbers of people who become eligible
for health insurance as well as continue
in their role as safety net providers.
Thus, understanding new models of
service delivery and improving
efficiency within FQHCs is of national
policy import. The proposed data
collection supports the goal of
developing a more efficient FQHC
service delivery model through studying
outcomes associated with a ‘‘delegate
model,’’ which is designed to improve
provider and team efficiency, and the
spread of this model throughout a large
FQHC.
Recent models of practice
transformation have documented the
use of an Organized Team Model that
distributes responsibility for patient
care among an interdisciplinary team,
thereby allowing physicians to manage
a larger panel size while practicing high
quality care. The delegate model
requires that all team members perform
E:\FR\FM\09JYN1.SGM
09JYN1
38902
Federal Register / Vol. 79, No. 131 / Wednesday, July 9, 2014 / Notices
at the top of their skill level, and that
tasks currently performed by clinicians
are delegated to non-clinician team
members in a safe and effective manner.
Researchers at the University of
California, San Francisco have
estimated that delegation may allow
physicians to increase their panel size
by shifting tasks to non-physician team
members. More specifically, if portions
of preventive and chronic care services
are delegated to non-physicians,
primary care practices can meet
recommended quality and care
guidelines while maintaining panel
sizes with a limited primary care
physician workforce. This study will
examine the real-world implementation
of such a model in order to build
evidence of whether such delegation
can achieve the predicted increases in
panel sizes.
AHRQ is working with John Snow,
Inc. (JSI) and its partner, Penobscot
Community Health Center (PCHC), to
evaluate the effectiveness and spread of
a delegate model in 5 of PCHC’s 15
primary care service sites. The model
will be spread from an initial pilot
physician-medical assistant team to
other clinics, as well as to other teams
within each clinic. PCHC is an FQHC
located in Bangor, Maine that serves
northeastern Maine.
Currently, PCHC’s primary care
providers (PCPs, which include medical
doctors, osteopaths, nurse practitioners,
and physician assistants) each work
with a Medical Assistant (MA). Under
the delegate model, a pair of PCPs will
be assigned an ‘‘administrative’’ MA to
enhance their team. This position will
enable shifting of responsibilities among
the team, with the intent of relieving the
PCPs of administrative tasks and
incorporating new tasks that will
enhance team efficiency. Examples of
tasks that an administrative MA may
take on include standardized
prescription renewals, schedule
management, in-box management,
scribing, pre-visit planning with preappointment laboratory tests, and
identification of patients for ancillary
referrals (e.g., behavioral health and
case management).
This study has the following goals:
(1) To evaluate the spread and
effectiveness of the delegate model in
five of PCHC’s primary care sites;
(2) To evaluate the influence of the
delegate model on provider satisfaction,
team functioning, and patient
satisfaction;
(3) To assess the contextual factors
influencing the above outcomes; and
(4) To disseminate findings.
This study is being conducted by
AHRQ through its contractor, JSI,
pursuant to AHRQ’s statutory authority
to conduct and support research on
health care and on systems for the
delivery of such care, including
activities with respect to the quality,
effectiveness, efficiency,
appropriateness and value of health care
services and with respect to quality
measurement and improvement. 42
U.S.C. 299a(a)(1) and (2).
Method of Collection
AHRQ seeks approval for the
following data collection activities:
• Team Survey that will be
disseminated to all members of both
delegate and non-delegate primary care
teams to assess job satisfaction and team
functioning in all participating sites at
two points in time.
• Key Informant Interviews
conducted with staff in each of the
participating sites during two rounds of
site visits, with key informants to
include the Medical Director, Practice
Director, members of primary care teams
implementing the delegate model, and
ancillary staff. A condensed version of
the interview will be used for a
conference call with each participating
site’s Medical Director and Practice
Director as an interim activity between
the two site visits.
The information yielded from this
study is expected to inform a wide cross
section of audiences and stakeholders
about provider efficiency, practice
redesign, team-based care, workforce
strategies, and spread of an innovation.
This study is not intended to make
broad generalizations about the
effectiveness of the delegate model of
care, but rather to build initial evidence
about this promising new model, its
ability to increase panel size in FQHCs,
and provide guidance on how similar
models might be spread and evaluated.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden for the respondents’
time to participate in this research.
Information will be collected through an
internet-based team survey and inperson and telephone interviews. Note
that some respondents may be doublecounted, so the total number of
respondents may be less than 80. For
example, a respondent may fill out a
survey as well as participate in a phone
interview.
Exhibit 2 shows the estimated
annualized cost burden associated with
the respondents’ time to participate in
this research. The total annual cost
burden is estimated to be $25,151.
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
responses per
respondent
Number of
respondents
Form name
Hours per
response
Total burden
hours
21
34
2
2
15/60
15/60
11
17
Total ...................................................................................................
sroberts on DSK5SPTVN1PROD with NOTICES
Team Survey:
–Providers .................................................................................................
–Other Clinical Staff .................................................................................
55
2
15/60
28
Key Informant Interviews (Site visits):
–Medical Director ......................................................................................
–Practice Director .....................................................................................
–Providers .................................................................................................
–Other Clinical Staff .................................................................................
2
2
5
10
2
2
2
2
30/60
30/60
30/60
30/60
2
2
5
10
Total ...................................................................................................
19
2
30/60
19
Key Informant Interviews (Phone calls):
–Medical Director ......................................................................................
–Practice Director .....................................................................................
3
3
1
1
1
1
3
3
VerDate Mar<15>2010
20:08 Jul 08, 2014
Jkt 232001
PO 00000
Frm 00053
Fmt 4703
Sfmt 4703
E:\FR\FM\09JYN1.SGM
09JYN1
38903
Federal Register / Vol. 79, No. 131 / Wednesday, July 9, 2014 / Notices
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued
Number of
responses per
respondent
Number of
respondents
Form name
Hours per
response
Total burden
hours
Total ...................................................................................................
6
1
1
6
Total ...........................................................................................
80
na
na
53
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Form name
Total burden
hours
Average hourly
wage rate *
Total cost
burden
Team Survey:
—Providers .............................................................................................
—Other Clinical Staff ..............................................................................
21
34
11
17
a $62.13
Total .................................................................................................
55
28
na
Key Informant Interviews (Site Visit):
—Medical Director ..................................................................................
—Practice Director .................................................................................
—Providers .............................................................................................
—Other Clinical Staff ..............................................................................
2
2
5
10
2
2
2
2
Total .................................................................................................
19
8
Key Informant Interviews (Phone calls):
—Medical Director ..................................................................................
—Practice Director .................................................................................
3
3
2
2
Total .................................................................................................
6
4
na
836
Total .........................................................................................
80
na
na
25,151
b 14.69
14,352
8,491
22,843
c 92.08
368
189
621
294
d 47.34
a 62.13
b 14.691
na
1,472
c 92.08
552
284
d 47.34
* National Compensation Survey: Occupational wages in the United States May 2012, ‘‘U.S. Department of Labor, Bureau of Labor Statistics.’’
a Based on the average mean wages for three categories of primary care provider ($92.08—MDs; $44.45 PAs; and $43.97—NPs).
b Based on the mean wage of Medical Assistants.
c Based on the mean wages for MDs.
d Based on the mean wages for Medical and Health Services Managers.
e Based on the mean wages for Data Analyst (Computer and Information Analyst).
sroberts on DSK5SPTVN1PROD with NOTICES
Request for Comments
In accordance with the Paperwork
Reduction Act, comments on AHRQ’s
information collection are requested
with regard to any of the following: (a)
Whether the proposed collection of
information is necessary for the proper
performance of AHRQ health care
research and health care information
dissemination functions, including
whether the information will have
practical utility; (b) the accuracy of
AHRQ’s estimate of burden (including
hours and costs) of the proposed
collection(s) of information; (c) ways to
enhance the quality, utility, and clarity
of the information to be collected; and,
(d) ways to minimize the burden of the
collection of information upon the
respondents, including the use of
automated collection techniques or
other forms of information technology.
Comments submitted in response to
this notice will be summarized and
VerDate Mar<15>2010
20:08 Jul 08, 2014
Jkt 232001
included in the Agency’s subsequent
request for OMB approval of the
proposed information collection. All
comments will become a matter of
public record.
Excess of the Poverty Income Level
From a State Program Funded Under
Part A of Title IV of the Social Security
Act.
OMB No.: 0970–0004.
Dated: June 25, 2014.
Richard Kronick,
AHRQ Director.
Description
[FR Doc. 2014–15806 Filed 7–8–14; 8:45 am]
BILLING CODE 4160–90–M
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Proposed Projects
Title: Annual Statistical Report on
Children in Foster Homes and Children
in Families Receiving Payment in
PO 00000
Frm 00054
Fmt 4703
Sfmt 4703
The Department of Health and Human
Services is required to collect these data
under section 1124 of Title I of the
Elementary and Secondary Education
Act, as amended by Public Law 103–
382. The data are used by the U.S.
Department of Education for allocation
of funds for programs to aid
disadvantaged elementary and
secondary students. Respondents
include various components of State
Human Service agencies.
Respondents
The 52 respondents include the 50
States, the District of Columbia, and
Puerto Rico.
E:\FR\FM\09JYN1.SGM
09JYN1

Agencies

[Federal Register Volume 79, Number 131 (Wednesday, July 9, 2014)]
[Notices]
[Pages 38901-38903]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-15806]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the intention of the Agency for
Healthcare Research and Quality (AHRQ) to request that the Office of
Management and Budget (OMB) approve the proposed information collection
project: ``Taking Efficiency Interventions in Health Services Delivery
to Scale.'' In accordance with the Paperwork Reduction Act of 1995,
AHRQ invites the public to comment on this proposed information
collection.
This proposed information collection was previously published in
the Federal Register on April 8th, 2014, and allowed 60 days for public
comment. No comments were received. The purpose of this notice is to
allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by August 8, 2014.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by email at
doris.lefkowitz@ahrq.hhs.gov.
Copies of the proposed collection plans, data collection
instruments, and specific details on the estimated burden can be
obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by email at
doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
Taking Efficiency Interventions in Health Services Delivery to Scale
The primary care workforce is facing imminent clinician shortages
and increased demand. With the implementation of the Affordable Care
Act (ACA), Federally Qualified Health Centers (FQHCs) are expected to
play a major role in addressing the large numbers of people who become
eligible for health insurance as well as continue in their role as
safety net providers. Thus, understanding new models of service
delivery and improving efficiency within FQHCs is of national policy
import. The proposed data collection supports the goal of developing a
more efficient FQHC service delivery model through studying outcomes
associated with a ``delegate model,'' which is designed to improve
provider and team efficiency, and the spread of this model throughout a
large FQHC.
Recent models of practice transformation have documented the use of
an Organized Team Model that distributes responsibility for patient
care among an interdisciplinary team, thereby allowing physicians to
manage a larger panel size while practicing high quality care. The
delegate model requires that all team members perform
[[Page 38902]]
at the top of their skill level, and that tasks currently performed by
clinicians are delegated to non-clinician team members in a safe and
effective manner. Researchers at the University of California, San
Francisco have estimated that delegation may allow physicians to
increase their panel size by shifting tasks to non-physician team
members. More specifically, if portions of preventive and chronic care
services are delegated to non-physicians, primary care practices can
meet recommended quality and care guidelines while maintaining panel
sizes with a limited primary care physician workforce. This study will
examine the real-world implementation of such a model in order to build
evidence of whether such delegation can achieve the predicted increases
in panel sizes.
AHRQ is working with John Snow, Inc. (JSI) and its partner,
Penobscot Community Health Center (PCHC), to evaluate the effectiveness
and spread of a delegate model in 5 of PCHC's 15 primary care service
sites. The model will be spread from an initial pilot physician-medical
assistant team to other clinics, as well as to other teams within each
clinic. PCHC is an FQHC located in Bangor, Maine that serves
northeastern Maine.
Currently, PCHC's primary care providers (PCPs, which include
medical doctors, osteopaths, nurse practitioners, and physician
assistants) each work with a Medical Assistant (MA). Under the delegate
model, a pair of PCPs will be assigned an ``administrative'' MA to
enhance their team. This position will enable shifting of
responsibilities among the team, with the intent of relieving the PCPs
of administrative tasks and incorporating new tasks that will enhance
team efficiency. Examples of tasks that an administrative MA may take
on include standardized prescription renewals, schedule management, in-
box management, scribing, pre-visit planning with pre-appointment
laboratory tests, and identification of patients for ancillary
referrals (e.g., behavioral health and case management).
This study has the following goals:
(1) To evaluate the spread and effectiveness of the delegate model
in five of PCHC's primary care sites;
(2) To evaluate the influence of the delegate model on provider
satisfaction, team functioning, and patient satisfaction;
(3) To assess the contextual factors influencing the above
outcomes; and
(4) To disseminate findings.
This study is being conducted by AHRQ through its contractor, JSI,
pursuant to AHRQ's statutory authority to conduct and support research
on health care and on systems for the delivery of such care, including
activities with respect to the quality, effectiveness, efficiency,
appropriateness and value of health care services and with respect to
quality measurement and improvement. 42 U.S.C. 299a(a)(1) and (2).
Method of Collection
AHRQ seeks approval for the following data collection activities:
Team Survey that will be disseminated to all members of
both delegate and non-delegate primary care teams to assess job
satisfaction and team functioning in all participating sites at two
points in time.
Key Informant Interviews conducted with staff in each of
the participating sites during two rounds of site visits, with key
informants to include the Medical Director, Practice Director, members
of primary care teams implementing the delegate model, and ancillary
staff. A condensed version of the interview will be used for a
conference call with each participating site's Medical Director and
Practice Director as an interim activity between the two site visits.
The information yielded from this study is expected to inform a
wide cross section of audiences and stakeholders about provider
efficiency, practice redesign, team-based care, workforce strategies,
and spread of an innovation. This study is not intended to make broad
generalizations about the effectiveness of the delegate model of care,
but rather to build initial evidence about this promising new model,
its ability to increase panel size in FQHCs, and provide guidance on
how similar models might be spread and evaluated.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden for the
respondents' time to participate in this research. Information will be
collected through an internet-based team survey and in-person and
telephone interviews. Note that some respondents may be double-counted,
so the total number of respondents may be less than 80. For example, a
respondent may fill out a survey as well as participate in a phone
interview.
Exhibit 2 shows the estimated annualized cost burden associated
with the respondents' time to participate in this research. The total
annual cost burden is estimated to be $25,151.
Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
Team Survey:
-Providers.................................. 21 2 15/60 11
-Other Clinical Staff....................... 34 2 15/60 17
---------------------------------------------------------------
Total................................... 55 2 15/60 28
---------------------------------------------------------------
Key Informant Interviews (Site visits):
-Medical Director........................... 2 2 30/60 2
-Practice Director.......................... 2 2 30/60 2
-Providers.................................. 5 2 30/60 5
-Other Clinical Staff....................... 10 2 30/60 10
---------------------------------------------------------------
Total................................... 19 2 30/60 19
---------------------------------------------------------------
Key Informant Interviews (Phone calls):
-Medical Director........................... 3 1 1 3
-Practice Director.......................... 3 1 1 3
---------------------------------------------------------------
[[Page 38903]]
Total................................... 6 1 1 6
---------------------------------------------------------------
Total............................... 80 na na 53
----------------------------------------------------------------------------------------------------------------
Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Number of Total burden Average hourly Total cost
Form name respondents hours wage rate * burden
----------------------------------------------------------------------------------------------------------------
Team Survey:
--Providers................................. 21 11 \a\ $62.13 14,352
--Other Clinical Staff...................... 34 17 \b\ 14.69 8,491
---------------------------------------------------------------
Total................................... 55 28 na 22,843
---------------------------------------------------------------
Key Informant Interviews (Site Visit):
--Medical Director.......................... 2 2 \c\ 92.08 368
--Practice Director......................... 2 2 \d\ 47.34 189
--Providers................................. 5 2 \a\ 62.13 621
--Other Clinical Staff...................... 10 2 \b\ 14.691 294
---------------------------------------------------------------
Total................................... 19 8 na 1,472
---------------------------------------------------------------
Key Informant Interviews (Phone calls):
--Medical Director.......................... 3 2 \c\ 92.08 552
--Practice Director......................... 3 2 \d\ 47.34 284
---------------------------------------------------------------
Total................................... 6 4 na 836
---------------------------------------------------------------
Total............................... 80 na na 25,151
----------------------------------------------------------------------------------------------------------------
* National Compensation Survey: Occupational wages in the United States May 2012, ``U.S. Department of Labor,
Bureau of Labor Statistics.''
\a\ Based on the average mean wages for three categories of primary care provider ($92.08--MDs; $44.45 PAs; and
$43.97--NPs).
\b\ Based on the mean wage of Medical Assistants.
\c\ Based on the mean wages for MDs.
\d\ Based on the mean wages for Medical and Health Services Managers.
\e\ Based on the mean wages for Data Analyst (Computer and Information Analyst).
Request for Comments
In accordance with the Paperwork Reduction Act, comments on AHRQ's
information collection are requested with regard to any of the
following: (a) Whether the proposed collection of information is
necessary for the proper performance of AHRQ health care research and
health care information dissemination functions, including whether the
information will have practical utility; (b) the accuracy of AHRQ's
estimate of burden (including hours and costs) of the proposed
collection(s) of information; (c) ways to enhance the quality, utility,
and clarity of the information to be collected; and, (d) ways to
minimize the burden of the collection of information upon the
respondents, including the use of automated collection techniques or
other forms of information technology.
Comments submitted in response to this notice will be summarized
and included in the Agency's subsequent request for OMB approval of the
proposed information collection. All comments will become a matter of
public record.
Dated: June 25, 2014.
Richard Kronick,
AHRQ Director.
[FR Doc. 2014-15806 Filed 7-8-14; 8:45 am]
BILLING CODE 4160-90-M